Provider Demographics
NPI:1548456254
Name:ROSHAU CHIROPRACTIC AND SPORTS INJURY CENTER, PC
Entity type:Organization
Organization Name:ROSHAU CHIROPRACTIC AND SPORTS INJURY CENTER, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:QUASCHNICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-221-2600
Mailing Address - Street 1:1715 BURNT BOAT DR
Mailing Address - Street 2:GALLATIN SUITE
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0812
Mailing Address - Country:US
Mailing Address - Phone:701-221-2600
Mailing Address - Fax:701-221-9082
Practice Address - Street 1:1715 BURNT BOAT DR
Practice Address - Street 2:GALLATIN SUITE
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0812
Practice Address - Country:US
Practice Address - Phone:701-221-2600
Practice Address - Fax:701-221-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND850111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U52058Medicare PIN
NDU52058Medicare UPIN